Differentiation of adult severe asthma from difficult-to-treat asthma – Outcomes of a systematic assessment protocol
Autor: | Niels Ulrik Søes-Petersen, Celeste Porsbjerg, Uffe Bodtger, Susanne Vest, Anna Von Bülow, Ida Steffensen, Vibeke Backer |
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Rok vydání: | 2018 |
Předmět: |
Adult
Pulmonary and Respiratory Medicine Severe asthma Pediatrics medicine.medical_specialty Asthma severity Severity of Illness Index Cohort Studies 03 medical and health sciences 0302 clinical medicine immune system diseases Administration Inhalation medicine Humans In patient Prospective Studies 030212 general & internal medicine Glucocorticoids Asthma Systematic assessment Protocol (science) Treatment barriers Asthma management business.industry Inhaler Difficult-to-treat asthma Middle Aged medicine.disease respiratory tract diseases Cross-Sectional Studies 030228 respiratory system Difficult to treat asthma business |
Zdroj: | von Bülow, A, Backer, V, Bodtger, U, Søes-Petersen, N U, Vest, S, Steffensen, I & Porsbjerg, C 2018, ' Differentiation of adult severe asthma from difficult-to-treat asthma : Outcomes of a systematic assessment protocol ', Respiratory Medicine, vol. 145, pp. 41-47 . https://doi.org/10.1016/j.rmed.2018.10.020 |
ISSN: | 0954-6111 |
DOI: | 10.1016/j.rmed.2018.10.020 |
Popis: | Background Guidelines recommend a differentiation of difficult-to-treat asthma from severe asthma. However, this might be complex and to which extent this distinction is achievable in clinical practice remains unknown. Objective To evaluate to which degree a systematic evaluation protocol enables a differentiation between severe versus difficult-to-treat asthma in patients in specialist care on high intensity asthma treatment, i.e. potentially severe asthma. Methods All adult asthma patients seen in four respiratory clinics over one year were screened prospectively for asthma severity. Patients with difficult-to-control asthma according to ERS/ATS criteria (high–dose inhaled corticosteroids/oral corticosteroids) underwent systematic assessment to differentiate severe asthma patients from those with other causes of poor asthma control: objective confirmation of the asthma diagnosis as well as assessment of treatment barriers and comorbidities. Results Overall, 1034 asthma patients were screened, of whom 175 (16.9%) had difficult-to-control asthma. 117 of these accepted inclusion, and completed systematic assessment. Asthma diagnosis was objectively confirmed in 88%. Sub-optimal adherence (42.5%), inhaler errors (31.5%) and unmanaged comorbidities (66.7%) were common. After primary assessment, 12% (14/117) fulfilled strict criteria for severe asthma. Moreover, 56% (66/117) were instantly classified as difficult-to-treat asthma due to poor adherence/inhaler technique. Finally, an ´overlap' group of 32% (37/117) were identified with patients being adherent and displaying correct inhaler technique, but had unmanaged comorbidities —potentially fitting into both the difficult-to-treat and severe group. Conclusion Only a minority of patients with difficult-to-control asthma were found to have severe asthma after primary systematic assessment. Nevertheless, strict categorisation of severe vs. difficult-to-treat asthma seems to pose a challenge. |
Databáze: | OpenAIRE |
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